Urgent improvements needed at MK Hospital

By Victoria Meakin

All women in advanced labour at Milton Keynes Hospital, must have one-to-one care from a registered midwife.

The ruling's been made today by the Care Quality Commission (CQC), which has found MK Hospital NHS Foundation Trust to be non-compliant with four out of the 16 essential standards of safety and quality.

Milton Keynes Hospital is one of just two hospital trusts - out of a total of 66 - which has been told it needs to make urgent improvements.

The 66 NHS trusts are being given a licence to provide services under a new, tougher system for regulating standards in the NHS.

But for Milton Keynes, registration is conditional on further action being taken to address concerns about the safety and quality of care.

The CQC has set out what action is required, with strict deadlines for the improvements to be made.

Roxy Boyce, the CQC regional director said,

"There are long-standing problems at this trust [Milton Keynes] in relation to its maternity services. The trust has not always responded fast enough to address concerns raised by patients or those raised by the regulator.

“We have imposed a number of conditions requiring action to ensure the safety of mothers and babies. Until all of these issues have been fully addressed, we are making it a legal requirement for this trust that all women in established labour receive one-to-one care from a registered midwife.

“We are doing this to protect the safety of mothers and babies. One-to-one care is in line with NICE guidance, which is not mandatory across the NHS. But, given the history of concern about staffing levels in the Milton Keynes maternity unit, we will make it a condition of registration in this particular case.

“This is not just about recruiting more midwives. It is about planning for demand and knowing what staff cover is needed for each shift, particularly when there are complicated births. It is about hour-by-hour professional management, to ensure that mothers receive the care they need.

“We have clearly set out the action we expect to see in the maternity unit and across the trust. We will continue to scrutinise the trust and will keep up the pressure until all standards are being met and all recommendations have been implemented.”

A Care Quality Commission report out earlier this year highlighted improvements which needed to be made on the unit. They included the recruitment of more midwives and an increase in the number of beds.

The CQC report was done following an inquest in to the death of baby Ebony McCall on the unit in May 2009. The deputy Coroner at the inquest for that case concluded the death was contributed to by systematic failures in maternity and neo natal care at the Trust. These failures ocurred despite the issues being highlighted in a previous Healthcare Commission report on maternity services at Milton Keynes in December 2008, following the death of baby Romy Feast.

Earlier this month Monitor - the independent regulator of NHS foundation trusts - ordered a team of external expert clinical advisors to intervene to speed up improvements on the maternity department.

"I think it hasn't come as a surprise to us and indeed this is what we would have expected to come through. We have an action plan in place that we're driving forward at great speed to make sure that we can have these conditions lifted."

And she told us what they are doing to recruit more staff:

"We're increasing the number of midwives that we have in the hospital, we're bringing in other staff to make sure that midwives aren't diverted to do other less clinical duties and what we're also making sure is that the number of mothers matches the number of midwives in the trust."

Other conditions which must be met by the hospital include:

Having appropriate systems to detect and monitor 'at risk' mothers and babies so suitable care is provided at all times

Having appropriate maternity escalation and risk management plans in place and in use by staff

Having sufficient senior midwife and obstetrician cover of the maternity department to manage demand and risk

Having a clear in plan to address outstanding Healthcare Commission recommendations

Ensure all midwives have comprehensive training in local maternity policies and procedures, escalation procedures and in promoting normal births.

In a statement Milton Keynes Hospital says:

The issues the Care Quality Commission identified are ones which we are well aware of and which we are already working hard to address. The restrictions on our registration announced by the Care Quality Commission do not mean that the services we provide at Milton Keynes Hospital are unsafe.

We have been listening closely to our patients, the Care Quality Commission and Monitor over the last few months and are working with them all to make sure that we improve our maternity services as quickly as possible.

The plan is already well underway and more midwives are joining the Trust over the next two months to add to the existing team. Last week we also appointed the first of our external experts who is coming into the Trust to provide invaluable additional support to accelerate the improvement programme we are delivering in maternity.

We are starting to see all of this work delivering results for our patients and are confident of being able to demonstrate to the Care Quality Commission that we are able to meet the conditions they have imposed on us within the deadlines they have set.

“We would like to reassure local women that our maternity department does provide a safe and quality service and that they will be well looked after when they come into the Trust. If any woman or their partner has any concerns at all about coming in to Milton Keynes Hospital to have their baby we would urge them to get in touch to talk these concerns through with us.

“Our team has been touched by the number of mothers who have recently contacted us, both directly and through the media, to tell us about the good experience they had at our unit.”